Thursday, July 1, 2010

Study done in 1999 on breech birth

Upright Positioning in Breech Births
An Obstetrician’s Impression

Photo of Dr Andrew Bisits

Since the beginning of 1999, 60 vaginal breech births have taken place using the BirthRite Seat at this hospital. One obstetrician has cared for these women. Unless the mothers had given birth to a previously big baby (larger than 4000 gm) they all had CT pelvimetry to ensure pelvic adequacy. In addition, an ultrasound was performed to assess fetal weight and head circumference. All the women and their partners received extensive counselling about the process of breech births and possible associated procedures. Risks were discussed, along with the safeguards that were in place in the face of these risks. Thirty-five women were primigravidae and twenty-five women were multigravidae.

During labour, most of the mothers did not have any form of analgesia. Only three of the women had epidurals. Once the epidural wore off and the mothers were ready to push, they used the BirthRite Seat as did all the other women.

A very important part of the care of labouring women at our hospital is taken by the midwives. Besides the positive effects of the continuous mental-emotional support they provide for the labouring mothers, there are a good number of midwives at our institution who feel confident with breech births. In addition, the one obstetrician attended all these births.

During the second stage of labour when there is a strong pushing urge, the women are seated on the BirthRite, with their partner supporting them from behind. The baby is monitored continuously. Should there be any perception that the contractions are inadequate close to the birth, Syntocinon is used to augment these contractions.

The baby’s body delivers spontaneously. The legs are not touched. An episiotomy had to be performed in only three out of the sixty mothers, due to fetal heart rate decelerations. Once the baby’s body is out to above the umbilicus, the mother gets up into a supported squat to encourage further descent of her baby. The shoulders are allowed to deliver spontaneously. If this does not happen reasonably promptly then they are swept out. L√∂vset manoeuvre is not used routinely but only in more difficult cases. In 50% of cases the baby’s head immediately follows the shoulders. If the head does not deliver spontaneously then it is flexed out with a finger in the mouth of the baby.

Photo of breech birth on Birthing SeatPhoto of breech birth on Birthing Seat

There have been no difficult births among the sixty mothers. All the babies have had good Apgar scores and there have been no cases of asphyxia. There has been one fourth-degree tear among the sixty women. This occurred in a woman who had an adequate pelvis and a small baby (2860 gm). No other cases of significant perineal trauma have occurred. One mild case of Erb’s palsy occurred in a second twin (unplanned vaginal breech delivery). This resolved by the time of the mother’s discharge from hospital. There have been no cases of significant birth injury to the baby. Only one of the babies weighed more than 4000 gm. The largest head circumference was 38 cm.The average was 34 cm.

This Birthing Seat seems to facilitate descent of the baby through the birth passage. The mothers can achieve excellent pushing and there is good access to the baby should manipulation be required.

80% of the mothers say that sitting on the BirthRite feels like a good position in which to push, in that the position on the seat assists them with focusing on this process.

Internal statistics of vaginal births show that, at our hospital, approximately one-third of mothers give birth on the bed, one-third give birth kneeling and just under one-third use the BirthRite Seat. The seat was designed by an experienced Midwife-Practitioner and introduced at our hospital in 1994 after a three-month trial and assessment period.

— Dr Andrew Bisits, FRACOG
Specialist Obstetrician
Newcastle NSW Australia
mdambi@mail.newcastle.edu.au


Tugging along

Ive started to revamp my diet . I haven't had a whole lot of ambition lately. I cant seem to figure it out. I'm pretty happy most days and I would say my moods are pretty constant but I cant seem to get the want to do anything. Someone mentioned it might be a slight case of depression. I have all these goals like reading 2 books in a week (I have a pile of 20 that I have to read), go running every day, some day complete a half marathon, lose 50 lbs., get my Doula certificate and start eating 80% raw. So far I'm about 60% raw and that has only been the last 2 weeks. Ive decided to stop buying unhealthy food and stop eating out as much so that I'm not tempted to eat all the junk. Problem is that I'm married and Chris has little interest in eating healthy so he likes to be the devils advocate and seduce me into eating junk (it really doesn't take much to break me). On the plus side, I have started juicing wheat grass, I'm taking wild yam, a female hormone tincture and red raspberry leaf tea to help with my hormones. We'll see how it goes. My goal is to read The Complete Book of Pregnancy and Childbirth by the end of this week.
Ive also been looking at taking herbs for the liver. A lot of sites list Dandelion, Burdock, Chamomile, Licorice and Milk Thistle as being really good herbs for the liver. I found a recipe on http://www.energiseforlife.com for a liver cleanse. It looks pretty simple so I might try it this weekend and see how it goes.

Liver Cleanse Recipe

Liver Cleanse Juice

This is an excellent liver cleanse recipe that I have adapted from about four or five other liver cleanse recipes that I have tried over the years. I have supercharged it with a few extra ingredients, but have put the main, base ingredients in bold to highlight the essentials.

I would recommend doing this over the weekend, and in the morning. It is particularly effective if you have undertaken some light exercise such as walking or jogging prior to the liver cleanse as this helps to get the toxins moving out of the body and invigorates the lymph system.

After the juice I would also recommend some breathing exercises to help the lymph flow on its way!

The Recipe for the Ultimate Liver Cleanse!

Serves 2

  • 2 large grapefruits
  • 4 lemons
  • 300ml of distilled water (or filtered)
  • 2 tablespoons of Udo’s Choice (or cold pressed flax oil
  • 1 teaspoon of acidophilus
  • 1-2 cloves of fresh garlic
  • 2 inches of fresh root ginger
  • Optional: a dash of cayenne pepper!

Directions

  1. Squeeze the juice of the grapefruit and lemon into a blender
  2. Next, grate the garlic and the ginger, and then using a garlic press, squeeze this into the juice
  3. Now add the water, Udo’s and acidophilus powder and blend for 30 seconds
  4. Add more ginger/garlic to taste

This juice contains all of the most potent liver cleansing ingredients, and gives your liver a gentle flush and the opportunity to heal itself. There are no side effects to this drink, apart from a bit of garlic-breath for a while. However, the grapefruit removes most of the odour.

I have also been told that this is the most incredible hangover cure in the world – so it might be worth bearing in mind just for that! It contains everything you would need to cure a hangover (vitamin c, omega 3, probiotics, water, ginger) so I can see how it would work!